A Pill is Not Enough

Psychologist Michael Browne on the failures of antidepressants

Browne: No, I didn't. But the drug companies have been exceedingly savvy in how they've tackled this. Twenty years ago people thought of depression as an emotion--depression meant you were sad. And you needed to find out why you were unhappy. The drug companies have done an exceedingly good job of convincing us all that depression is a medical disease. And that message has been one of the things that has led people to depend so much on these drugs.

As it turns out, and I say this based on looking very carefully at the research: These drugs have little or no effectiveness. They simply don't help that much. You can always point to individual patients who will say that any treatment is wonderful, it's cured them. That's why people go around wearing copper bracelets. There are people who say, "I had terrible arthritis and this copper bracelet cured my arthritis."

And it's not really so surprising that these medications don't work. If a person is very seriously unhappy, and it goes on for months and months, what does that mean? That means there's something very seriously wrong in that person's life. It's not for trivial reasons. And common sense tells us it's not likely to be easy to change that.

Michael Browne: "I really began to wonder if medication helped any of my patients."
Craig Lassig
Michael Browne: "I really began to wonder if medication helped any of my patients."

Now, it may be that some drugs will provide symptomatic relief. And there may be some times at which symptomatic relief can be important. And so there should be a respectable but small place for the use of drugs in treating emotional disorders. For instance, with Tourette's syndrome, children can develop facial tics and other symptoms that make them objects of ridicule by their friends. If medication, properly used, can reduce or eliminate those tics, we've done the child a great favor.

The problem that we get into is that again and again, we start prescribing a psychiatric medication for symptomatic relief and then we lose sight of that fact and we think that we are providing a cure, and the drugs can't do that. And that's been reenacted over and over again in the history of psychiatry in the last 50 years.

We know from reading the newspaper the last several months that medication is not a safety net. I think that what is less widely known probably is that for 10 years there's been research that shows that the antidepressants don't reduce the frequency of suicide. That's well documented. And now we've been finding recently that for some individuals the drug actually increases the suicide rate. What Peter Breggin [the author of the 1990s bestseller Talking Back to Prozac] says is that in some cases people are very despondent, and you give them a drug which artificially makes them more energetic, and that's not a good combination. Breggin thinks that's the danger of many of these drugs.

CP: That might make sense of why they don't mix well with children.

Browne: Yes. They're already impulsive. And when you have someone who's despondent and impulsive, and you give them something that probably increases their energy and maybe their impulsiveness, then you've got real trouble.

Psychologists and psychiatrists who talk about medication being harmful rather than helpful, and who talk about not referring patients for medication--they sometimes get treated like kooks. They can even be threatened with malpractice lawsuits. When I've said to people that I don't think we should be referring so many people for medication, that is one of the first things psychologists say back to me: "I agree with you, but I would never do that, because I am concerned about getting sued for malpractice."

I think what prevents people from committing suicide is not some drug. What prevents you from committing suicide is having a relationship with someone who cares. And if I can form a relationship with a patient and show them that I sincerely care about that person, that's what's going to keep them from committing suicide.

I've seen cases where the therapist not only refers the patient for medication, but stops seeing the patient. You need medication, not therapy. That can be experienced as supreme rejection for the patient. The other danger is that if you are talking to a person who is very depressed and you say to them, "Go see this psychiatrist," it can feel like you the psychologist are feeling hopeless or frightened about the patient's depression. So referring someone to a psychiatrist for medication is not simply a benign act. It has a lot of meaning for the patient and can be very disturbing to patients, and that is not sufficiently recognized by therapists.

The irony is that you take some kid or some adult, and he's been kicked around a lot, maybe abused in childhood, or neglected. He's had a lot of bad treatment. So what has that treatment made him? Mistrustful, angry, difficult to be around. It's the ultimate irony that we take people who've been badly treated, and they're somewhat obnoxious to be around, and the therapist who's supposed to treat this person then rejects them too. What psychologists need to do is be mentally healthy enough themselves that they can see the good in this person. No matter what they've done or what kind of trouble they've been in, you have to see the value of this human being. But it's exactly true that we often just don't want to look at these people.

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